Early Detection of Microvascular Impairments With Optical Coherence Tomography Angiography in Diabetic Patients Without Clinical Retinopathy: A Meta-analysis

Zhang, Bilei; Chou, Yi-Hung; Zhao, Xinyu; Yang, Jingyuan; Chen, Youxin

doi:10.1016/j.ajo.2020.09.032

Cited by 56 publications

(45 citation statements)

References 61 publications

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“…21,22 Early detection of ophthalmoscopically nonvisible neurovascular changes with OCTA has been tested in patients with diabetes before the first clinical signs of DR appear. 23e25 In this context, a recent meta-analysis showed that a decrease in the vascular density values could be detected on OCTA images in eyes without overt DR. 23 However, it is notable that our study showed that the differences in vessel density between groups is small, detecting a reduction in vessel density of approximately 5% in the patients with DM and no DR and of 10% in the patients with DM and DR.…”

Section: Discussioncontrasting

confidence: 54%

Quantitative Parameters from OCT Angiography in Patients with Diabetic Retinopathy and in Those with Only Peripheral Retinopathy Compared with Control Participants

Hogg

Wright

Dolz-Marco

et al. 2021

Ophthalmology Science

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Purpose: To describe the differences in a range of quantitative OCT angiography (OCTA) metrics across early stages of diabetic retinopathy (DR), providing robust effect estimates as well as sensitivity and specificity.Design: Cross-sectional study with population-based sampling.Participants: Four hundred forty-one eyes from 296 individuals: 328 control eyes (no diabetes mellitus [DM] and no DR), 55 eyes with DM and no DR, and 58 eyes with early nonproliferative DR.Methods: Multimodal retinal imaging included color fundus photography, color Optomap ultra-widefield imaging, and spectral-domain OCT (Spectralis OCT2; Heidelberg Engineering GmbH) with the OCTA module. All images were graded for the presence and severity of DR features. OCTA images were assessed manually for inclusion based on quality. Binary OCTA metrics were assessed after 3-dimensional projection artifact removal including from the nerve fiber layer vascular plexus, superficial vascular plexus (SVC), and deep vascular plexus (DVC) by Early Treatment Diabetic Retinopathy Study (ETDRS) grid, foveal avascular zone (FAZ) area, FAZ minimum and maximum diameter, perimeter length, and circularity.Main Outcome Measures: Diabetes mellitus and DR status and presence or absence of DR in the retinal periphery.Results: The reduction in vessel densities in participants with DM and manifest DR compared with control participants tended to be twice that of those with DM, but no DR, compared with control participants. Some evidence of spatial heterogeneity in vessel reductions was found in those yet to develop DR, whereas those with manifest DR had significant reductions across the ETDRS grid. The FAZ perimeter and circularity were impacted most significantly by DM, and those with DR showed decreased multispectral fractal dimensions compared with control participants. Eyes with peripheral DR had reduced vessel density compared with those with DM and no DR only in the superior outer, temporal inner, and temporal outer regions in the DVC and SVC. The area under the receiver operating characteristic curve ranged between 0.48 and 0.73.Conclusions: Significant differences in OCTA metrics can be found in those with DM before manifest DR using commercially available equipment with minimal image postprocessing. Although diagnostic performance was poor, these metrics may be useful for measuring change over time in clinical trials. Ophthalmology

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Section: Discussioncontrasting

confidence: 54%

Quantitative Parameters from OCT Angiography in Patients with Diabetic Retinopathy and in Those with Only Peripheral Retinopathy Compared with Control Participants

Hogg

Wright

Dolz-Marco

et al. 2021

Ophthalmology Science

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“…We noticed no significant difference in FAZ; this may be explained by the high interindividual variability of the FAZ size [27,28]. A recent meta-analysis of OCTA findings in NDR patients demonstrated an enlarged FAZ area and lower VD in the macular SCP and DCP compared to healthy subjects [23]. Simonett and coworkers noticed significant reduction of the VD in the parafoveal DCP along with the unchanged FAZ area in patients with type 1 DM and NDR compared to healthy controls [29].…”

Section: Discussionmentioning

confidence: 57%

“…e trend of disease progression at the preclinical stage of DR is different between the two types of DM. In a recent meta-analysis, Zhang et al elucidated that microvascular impairment in OCTA of subjects with NDR were more noticeable in type 2 DM [23]. It is believed that patients with type 1 DM tend to experience a quiescent period followed by a rapid progression to the nonproliferative stage.…”

Section: Discussionmentioning

confidence: 99%

Retinal Vascular Response to Hyperoxia in Patients with Diabetes Mellitus without Diabetic Retinopathy

Safi

Nourinia

Safi

et al. 2021

Journal of Ophthalmology

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Purpose. To evaluate the retinal vascular response to hyperoxia in patients with diabetes at the preclinical stage of diabetic retinopathy (DR) and to quantify the changes in comparison with normal subjects using optical coherence tomography angiography (OCTA). Methods. In this prospective study, 40 eyes of 20 participants comprising 10 diabetic patients with no diabetic retinopathy (NDR) and 10 normal subjects were recruited. OCTA images were acquired in the resting position and were repeated after a hyperoxic challenge using a nasal mask connected to a reservoir bag supplying 100% oxygen at the rate of 15 L per minute for 5 minutes. The changes of mean parafoveal vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), the foveal avascular zone (FAZ) size, and the outer retina flow index were compared between two conditions in each group and between the two study groups. The statistical significance of differences in the means was evaluated using Student’s t-test for unpaired samples with consideration of the generalized estimating equations (GEE) for intereye correlation. Results. At baseline, the mean parafoveal VD of SCP and DCP were significantly lower in the NDR participants compared to the healthy subjects (P < 0.001 and P = 0.006, respectively). After induction of the hyperoxic challenge in healthy participants, mean parafoveal VD reduced at both the SCP and DCP, but reached a statistical significance only in DCP (P = 0.006). However, following induction of hyperoxic challenge in patients with NDR, no significant decline was noticed in mean parafoveal VD of SCP and DCP. The degree of change in mean parafoveal VD of DCP was statistically significantly more pronounced in healthy subjects compared to the NDR group (P = 0.034). The change in FAZ size and the outer retina flow index were comparable between the two study groups. Conclusion. Retinal capillary layers responded differently to hyperoxia-induced challenge, and in normal subjects, the autoregulatory mechanism was mostly effective in the parafoveal DCP. Retinal vascular reactivity was impaired in SCP and DCP at the preclinical stage of DR. OCTA as a noninvasive modality was able to quantify the retinal vascular response to the hyperoxic challenge.

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“…OCTA as a noninvasive technique has been introduced to observe multiple retinal findings of DR from mild capillary drop out to retinal neovascularization. 14 , 15 Multiple ocular and systemic diseases such as glaucoma, Marfan syndrome, Fabry disease and Alzheimer's diseases were evaluated with OCTA and found to be correlated with retinal microvascular changes. 16 – 19 With the improvement of projection artifact removal technique, the analysis of DCP becomes more accurate and reliable.…”

Section: Discussionmentioning

confidence: 99%

Detection of the Microvascular Changes of Diabetic Retinopathy Progression Using Optical Coherence Tomography Angiography

Wang

Han

Sun

et al. 2021

Trans. Vis. Sci. Tech.

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Purpose To investigate microvascular parameters that are related to the severity of diabetic retinopathy (DR) with optical coherence tomography angiography (OCTA). Methods In total, 105 eyes from 105 diabetic patients were recruited in this prospective cross-sectional study, including 37 eyes with no clinical signs of DR (NoDR), 43 eyes with nonproliferative diabetic retinopathy (NPDR), and 25 eyes with proliferative diabetic retinopathy (PDR). Angiogram images from the parafoveal superficial capillary plexus (SCP), the deep capillary plexus (DCP), and the radial peripapillary capillary plexus were analyzed, and metrics were compared among groups. Multivariate regression analysis was used to identify the best OCTA parameters that could distinguish DR severity among groups. Results Parafoveal vessel diameter index in the SCP and vessel density (VD) in the DCP showed the strongest correlation with the severity of DR ( P < 0.01). Extrafoveal avascular area in the SCP was the parameter that could most distinguish NoDR from NPDR ( P < 0.01) with sensitivity and specificity of 83.72% and 78.38%, respectively. VD in the DCP also was the most sensitive biomarker to distinguish NPDR from PDR ( P < 0.01) with sensitivity and specificity of 84.00% and 79.07%, respectively. Conclusions The microvascular changes in the SCP and DCP in DR may have different characteristics that could be identified with specific OCTA parameters. OCTA serves as a promising technology to discriminate eyes with different severity of DR. Translational Relevance Our study investigated OCTA metrics and severity of DR. At different stages of DR, ophthalmologists may focus on specific OCTA parameters to predict the progression of retinopathy in individual patients.

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Early Detection of Microvascular Impairments With Optical Coherence Tomography Angiography in Diabetic Patients Without Clinical Retinopathy: A Meta-analysis

Cited by 56 publications

References 61 publications

Quantitative Parameters from OCT Angiography in Patients with Diabetic Retinopathy and in Those with Only Peripheral Retinopathy Compared with Control Participants

Quantitative Parameters from OCT Angiography in Patients with Diabetic Retinopathy and in Those with Only Peripheral Retinopathy Compared with Control Participants

Retinal Vascular Response to Hyperoxia in Patients with Diabetes Mellitus without Diabetic Retinopathy

Detection of the Microvascular Changes of Diabetic Retinopathy Progression Using Optical Coherence Tomography Angiography

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